58-53-1. Definitions. As used in this Article, the following terms have the meanings specified: (1) "Group policy" means a group accident and health insurance policy issued by an insurance company and a group contract issued by a service corporation or health maintenance organization or similar corporation or organization. (2) "Individual policy" or "converted policy" means […]
58-53-10. Eligibility. Continuation shall only be available to an employee or member who has been continuously insured under the group policy, or for similar benefits under any other group policy that it replaced, during the period of three consecutive months immediately before the date of termination. The employee or member may elect continuation for a […]
58-53-100. Alternative plans. At the option of the insurer, such plans of benefits set forth in G.S. 58-53-90 and 58-53-95 may be provided under one policy. Instead of providing the plans of benefits set forth in G.S. 58-53-90 and 58-53-95, the insurer may elect to provide a policy of comprehensive medical expense benefits without first […]
58-53-105. Insurer option. The insurer may, at its option, offer alternative plans for group health conversion in addition to those required by this Part. Furthermore, if any insurer customarily offers individual policies on a service basis, that insurer may, in lieu of converted policies on an expense incurred basis, make available converted policies on a […]
58-53-110. Other conversion provisions. (a) If coverage would in any event have been continued under the group policy on an employee following his retirement prior to the time he is or could be covered by Medicare and provided he would have been eligible for continuation under the group policy as specified in G.S. 58-53-10, the […]
58-53-115. Article inapplicable to certain plans. The provisions of this article shall not apply to hospital, surgical or major medical plans offered by employers on a self-insured basis. (1981, c. 706, s. 2.)
58-53-15. Exception. Continuation shall not be available for any person who is or could be covered by any other arrangement of hospital, surgical, or medical coverage for individuals in a group, whether insured or uninsured, within 31 days immediately following the date of termination; or whose insurance terminated because he failed to pay any required […]
58-53-20. Benefits not included. Continuation is not required to include dental, vision care, or prescription drug benefits, or any other benefits provided under the group policy in addition to its hospital, surgical, or major medical benefits. (1981, c. 706, s. 1.)
58-53-25. Notification to employee. In addition to the notification requirement set forth in G.S. 58-53-40, notification may be included on insurance identification cards or may be given by the employer, orally or in writing as a part of the exit process from the employment. (1981, c. 706, s. 1.)
58-53-30. Payment of premiums. An employee or member electing continuation must pay to the group policyholder or his employer, in advance, the amount of contribution required by the policyholder or employer, but not more than one hundred two percent (102%) of the full group rate for the insurance applicable under the group policy on the […]
58-53-35. Termination of continuation. (a) Continuation of insurance under the group policy for any person shall terminate on the earliest of the following dates: (1) The date 18 months after the date the employee’s or member’s insurance under the policy would otherwise have terminated because of termination of employment or members; (2) The date ending […]
58-53-40. Notification. A notification of the continuation privilege shall be included in each individual certification of coverage. (1981, c. 706, s. 1.)
58-53-41. Extension of election period and effect on coverage. (a) Definitions. – As used in this section, the following terms have the meanings specified: (1) "Act" means the federal American Recovery and Reinvestment Act of 2009, P.L. 111-5, effective February 17, 2009. (2) "Assistance eligible individual" has the same meaning as found in section 3001 […]
58-53-45. Right to obtain individual policy upon termination of group hospital, surgical or major medical coverage. A group policy delivered or issued for delivery in this State that insures employees or members for hospital, surgical, or medical insurance on an expense incurred or service basis under Articles 1 through 67 of this Chapter other than […]
58-53-5. Continuation of group hospital, surgical, and major medical coverage after termination of employment or membership. A group policy delivered or issued for delivery in this State that insures employees or members for hospital, surgical or major medical insurance on an expense incurred or service basis under this Chapter, other than for specific diseases or […]
58-53-50. Restrictions. A converted policy shall not be available to an employee or member if termination of his insurance under the group policy occurred because: (1) Of termination of employment or membership and either he was not entitled to continuation of group coverage under Part 1 of this Article or failed to elect such continuation; […]
58-53-55. Time limit. In order to be eligible for conversion, written application and the first premium payment for the converted policy must be made to the insurer not later than 31 days after the date of termination of insurance provided under Part 1 of this Article. The effective date of the converted policy shall be […]
58-53-60. Premium. (a) The premium for the converted policy or group conversion trust certificate shall be determined in accordance with the insurer’s table of premium rates applicable to the age and class of risk to be covered under that policy and to the type and amount of insurance provided. (b) All insurers licensed to do […]
58-53-65. Coverage. The converted policy shall cover the employee or member and his eligible dependents who were covered by the group policy on the date of termination of insurance. At the option of the insurer, a separate converted policy may be issued to cover any such eligible dependent. (1981, c. 706, s. 1.)
58-53-70. Exclusions. An insurer shall not be required to issue a converted policy covering any person if such person is or can be covered by Medicare. Furthermore, an insurer shall not be required to issue a converted policy covering any person if: (1) a. Such person is covered for similar benefits by another hospital, surgical, […]
